Vulnerability and Self-Disgust with C – Week 36

Thursday was the first day back to therapy after C’s Christmas break.  It was a successful session in a long-term sort of way, but was nevertheless very traumatic for me, tackling as it did a lot of hurt and vulnerabilities that I don’t want to face nor admit to.  There was nothing specific that was so stressful about it, but as I said to C towards the end, I felt very “battered and bruised”.

I was glad to see C again, having missed him and craved his protection over the three weeks since I last saw him.  However, he has committed a cardinal sin.  He has grown a beard.  Not like the goatee, Derren Brown-esque beard he had when we first met, but a full-on, proper beard.  I’ve nothing especially against beards, but honestly – he looks like something out of a children’s illustrated Bible.  When he came to the waiting room to get me, I was aghast to be greeted by Jesus (or Judas if you prefer, he could be either).  It took me a quite a while to stop fixating on this newly arrived hirsute feature.

As has been the case since C has been back in VCB’s stomping ground (as there is building work going on in his office), we opened by taking a few moments to compose ourselves.  The waiting room in the place is usually full of people, unlike that for C’s proper office which is always empty.  The people unsettle me, and C has realised now that he has to give me a few minutes for this anthropophobic anxiety to abate somewhat.

Of course, I had C anxiety as well.  I always feel nervous before I see him, and it was especially strong on Thursday given that I had not seen him for three weeks.  To that end, initially I was stubbornly refusing to speak in anything other than one word answers to questions.

Eventually, he asked me how Christmas had been.

“I’m not going to discuss that,” I brattishly declared.  I knew, of course, that he would follow that up with a question as to why I was not going to discuss that, so before he got the chance to do so, I changed the subject and told him about the latest troubles with the health service.

The first thing was the whole bullshit about the GP talking down to me, just after I’d last seen C.  I told him all about it, going so far as to re-enact some of the mannerisms that Dr Arsehole had employed during his irritable rant towards me.  This was before the reply to my complaint had arrived.

“How dare someone earning as much as a GP does behave in that fashion?” I raged.  “How dare the jumped-up twat speak to me like that?”

“How were you in the room with him?” asked C.

“Pathetic,” I admitted.  “I just sat there and took it.  I did try to argue with him at one point, but he just kept on and on, and I backed down.  As I was leaving, I even thanked him!  A reckons I need to discuss my remarkable ability to be so horribly passive with you.”

The second NHS issue, which I’ve only mentioned in passing here, is that apparently VCB is no longer my consultant psychiatrist.  When I last saw her in November, she said she’d see me again in a month, which she didn’t (surprise surprise).  Then, when I finally did get a letter inviting me for an appointment with Psychiatry, it merely said that I had an appointment on 20 January with Dr M, not VCB.  It made no reference as to the change of individual whatsoever.

C said, “as far as I know there’s been a shake-up in Psychiatry in terms of geographical location.  They’ve changed the boundaries that each consultant operates in.  Is that what happened?”

“No one told me anything, so I wouldn’t know,” I spat, disgusted.

“I’m not going to lie to you,” I continued, “I’m not VCB’s biggest fan.  But at least I had some sort of relationship with her – I knew her, and she was at least in some ways familiar with my case, so this is incredibly frustrating.  It strikes me that Psychiatry is possibly the worst branch of medicine in which such nonchalance and disruption should be in evidence, what with issues of trust and attachment being so much a part of certain illnesses.

“But what do I know,” I added bitterly.  “I’m just the mental that sits opposite you people.”

“Is that how you see yourself?” C jumped in.

The truthful answer to this is that I don’t know.  The comment had been intended as a slight on the Psychiatric “service” and indeed on mental health services on the NHS in general, but of course I exist in a perpetual state of self-loathing and self-disgust, whether im- or explicit, so yes, it probably is – to some extent – how I see myself.

I told him so, adding that I have no right to be mental because what has happened to me is so considerably less serious than that to which many others have been subjected.  This came up a couple of times in the session – basically I feel guilty for being a mental when other people who’ve endured worse aren’t or, if they are, then they have more right to be than I.

C mulled it over for a minute or two, then said, “one thing about you is that you’re defined by contradictions.  You mentioned earlier about being passive – there is that side, yet there’s another side that can be extremely assertive in the right circumstances.  It’s the same with your belief that you are somehow not entitled to be a mentalist [interesting use of that word, I thought].  You hate yourself for being this way, you think you have no right – yet you will fight to the death to get the treatment to which you feel you are entitled.”

“It’s hardly rocket science, though,” I responded.  “In some ways, whether or not I’m entitled to be mad is irrelevant; the fact is, I am.  Regardless of the reasons for that, I should be entitled to treatment, under the foundations on which this health service was based.  If I kicked that wall over there and broke my toe, the stupid manner in which I broke my toe would be irrelvant to those treating me; I would still be entitled to their medical attention.  I don’t see why it should be different for one’s mental health.”

“It shouldn’t,” he agreed.

Oh really?  OK then, why are you cutting short my fucking therapy?  Not that I brought up that issue specifically, because I didn’t want to engage in the pointless navel-gazing that had been the previous session.  If our time is limited, it must be used effectively.

Anyhow, I don’t remember how he phrased it, but basically he said that a person’s history and indeed how they respond to it is completely relative.  He said that we can only develop from our own experiences and, essentially, that I really shouldn’t beat myself up for being mental.  Later on in the session, he almost went so far as to say that I have every right to be, but I’ll come to that later.

Of course, I can rationally accept a lot of this, and indeed I know that certain mental illnesses with which I have been diagnosed are thought to exist in individuals who are biologically predisposed to having them, the symptoms manifesting after some sort of psychosocial trigger.  So of course I am not to be blamed for being mental…says Rational Me.  In-Control-Irrational-and-Ironically-Mental Me does not agree.

We also discussed how the anger I feel is sometimes misplaced.  I contend absolutely that my anger towards the health service is completely just, so that’s not one such example, but I will fly into a genuinely murderous rage at either myself or, say, my mother (particularly my mother) for something ridiculously stupid like dropping a pen – yet I am not angry at my uncle.  I am angry at my father, but that miserable sod had the audacity to die, so I’m hardly likely to be able to direct that towards him.

Of course, mention of my uncle in the context of anger was A Very Bad Move.  C said, “so, are you going to tell me what happened at Christmas?”

I glared at him.  “Did I not already say that I don’t want to talk about that?” I sneered, eventually.

“You did, yes.”  He looked at me enigmatically.

Oh, but you can read my mind, can’t you C?  Saying that I didn’t want to talk about it is some sort of conspiratorial Newspeak for, “I want to discuss that with you in intimate and excruciating detail”, isn’t it?!

“You don’t want to tell me about your Christmas, do you?  No – you don’t.  So why should I tell you about mine?” I challenged.

It was meant mainly as a sarcastic and rhetorical question, but he answered anyway.  “If we met in other circumstances, that’s probably exactly the conversation we’d be having,” he mused.  “But I know that you know that this circumstance has to be one-sided.”

As it happens, I do know, thanks very much – and I don’t like it and it isn’t fair.  And yet it protects me from the probable sheer ordinariness of this man that I so pathetically look up to.  But that’s another matter.  I told him, truthfully, that if we met socially, I would still not be telling him the specifics of what happened at Christmas.

Actually, if I’m 100% honest, of course I wanted to discuss it with him (in his capacity as my psychotherapist) – aspects of it anyway.  I was horribly mortified (as well as disturbed) by what ‘They’ wanted me to do on Christmas Night, and didn’t especially want to outline that in specific terms, but I did want to tell him of the fear and anguish that took me to that point.  Yet I felt absolutely unable to give myself permission to do so.

We sat in silence for a bit.  I knew he would break me sooner or later, but I decided to fight him anyway.  I was thinking about the psychoses, which led me to question how I had described them here on WordPress.  In doing so, I was reminded that I won an award for this blog on New Year’s Day from the fabulous Mental Nurse blog.

“My blog won an award,” I randomly blurted out at him, with thinly-disguised pride.

C seemed quite excited by this news and congratulated me, then paused.  “I really want to ask you more about this,” he began, “But I’m wondering if we shouldn’t leave it until later – I don’t want to avoid the issue of Christmas.”

I wanted to avoid the issue of Christmas.  It’s my fucking therapy, can’t I talk about what I like?

But I gave up the fight, and gave the man what he wanted.  “There were issues with the voices,” I admitted finally, tapping my head (as if he didn’t know what voices I damn well meant).

“OK,” he started.  “What sort of ‘issues’?”

“No, no, no, we’re not going down that road.  It’s enough that you know that the day was stressful and I went doolally in the evening, though mercifully not in front of the 3,820,691 people with whom I was forced to spend the whole sorry day.”

“But how could it not have been traumatic?” C asked.  “I really fail to see how it could not have been, what with you having to see and interact with your uncle.”

“You’ve built it to be all about him,” I replied.  “It’s not – not entirely.  To say my family is a freakshow is to insult freakshows.  I just cannot put into words how fucked up and weird they all are, and how much I have nothing in common with them.”

“I remember you saying before that their ‘weirdness’ was difficult to convey, but I do have some sense of that.”

“They’re worse in a collective,” I continued.  “As individuals – well, I can’t pretend I’m their biggest fans, but they’re more tolerable.  But their group dynamic is seriously – epically [not that that’s a word] – bizarre.”

Moving away from this slightly, C went back to the voices.  I told him that I had already said I was not going into that and requested that he left it be.

“I’m not really so concerned about what they actually said,” he told me.  “At present I’m more interested in why you don’t want to tell me about it.”

I should have been expecting such a question, but I hadn’t been.  I thought about it for a moment.

“I’m very aware that we’re sitting in Psychiatric Outpatients and that the bin’s over there,” I said, leaving him to infer the rest.  “I can’t get away quickly here.  At least in your normal office I have time to flee before you all catch me.”

I got the usual spiel of crap about how he would only call a psychiatrist or my GP if I was at a serious and imminent risk of harming myself.  Or others, he added, almost as an afterthought.  I laughed bitterly.

I don’t remember the exact discussion that followed, but he seemed to have established that on Christmas Night it was ‘others’ that ‘They’ were trying to get me to hurt.  He never said it straight out, and I never confirmed it, but there seemed to be a shared, implicit understanding that this was what had occurred.  He sought to reassure me in as strong terms as he’s allowed to that he would not call anyone to have me sectioned unless he thought that such harm was absolutely imminent.

“I don’t believe you,” I told him.

Ouch.  I think that one cut him a little (no pun intended, not that I’ve been too bad vis-a-vis self-harm of late).  He asked why I doubted him.

In part, it is because I feel that some of the trust has been broken between us, owing to the whole uncertainty over the continuation of treatment – though in fairness, he was good in this session and I feel it might have been built up a little again.  Other reasons are just how terrible the episode was – I mean, I was told to kill a fucking not-quite-two year old, how much worse does it get? – and the fact that I’m preposterously paranoid.  Probably the simplest reason is that I often genuinely feel that I should be fucking sectioned, though I really, really don’t want to be.

In any case, I do believe that C wouldn’t section me unless he felt it absolutely imperative, yet I don’t believe it at the same time.  I believe two absolutely polar opposite things simultaneously – not an unknown state for me.  I told him so, and he seemed to understand that.

For some reason, presumably relating to all the discussion about Paedo and the multitudinous weirdness of the McF dynasty, C and I ended up discussing how my mother didn’t believe me about the sexual abuse, and about how she seems to go out of her way sometimes to put me down, or to compare me (negatively) to others (particularly SL, who she seems to fucking idolise).

C said, “it seems to me that your mother has been severely traumatised by her relationship with your father.”  Now, I genuinely don’t recall what he said next, but I think it was something along the lines that she therefore seeks solace in the McFs and, despite what she may say, finds it hard to believe that they are capable of fault – even when it’s rape of her daughter.  I don’t want to put words in C’s mouth, though, so don’t take that as gospel.  Of course, whilst I cannot disagree with the aforesaid conjecture, my own take on things is that she will always remember that I am my father’s daughter (she will even say it from time to time when she wants to hurt me).  In any case, I am certainly not the daughter that she would have wanted.

I agree with C that she is completely traumatised (not that she’d admit it herself), but was surprised by him coming out and telling me that was his view in such forthright terms.  In any event, this tangent didn’t especially add much to the session, except to exacerbate the rawness of the hurt I was already feeling.

So that was his next tactic – the perennial, “how are you feeling?”

I couldn’t verbalise it at first.  I just felt so something, so indefinably sad and upset and low.  He quietly encouraged me to try harder to express it more exactly.

Eventually, through gritted teeth, I seethed, “I feel hurt and sorry for myself and vulnerable, are you happy now?”

Unfortunately he thought this comment was sarcastic, intended as a snide take on what he wanted to hear.  Admittedly, the manner in which I had said it could easily have been taken that way, though it was meant to have come across as a dramatic, “there!  I’m finally admitting the truth!  I’m deflated but this is progress, isn’t that fantabulous?” kind of gesture (fail!).  I apologised, and advised him that the content of my comment was serious.

Yes, I admitted to being vulnerable.  What I didn’t admit, of course, is that I want C to protect me from all that which makes me vulnerable.  I want him to put his arms around me, stroke my hair, tell me in his gentle voice I will be OK, and protect me from all the bad that exists in the world.  Of course I didn’t tell him that, but admitting to this hideous vulnerability that I’ve been repressing for I don’t-know-how-long was a start.

“Unwillingness to feel or express feeling of these things is very common in people who’ve been brought up in abusive and traumatic backgrounds,” he told he, tilting his head to gauge my reaction.

“‘Abused’,” I repeated wistfully, looking away.  The branches of the trees outside were blowing back and forth in the wind, stripped bare of their leaves.  I felt as emotionally naked in front of C as they looked.

“You don’t think you’ve been abused?” he checked, apparently confused.

“No,” I replied quietly.

“You were sexually abused by your uncle!” C said, determinedly.

“And I responded to that and other things by dissociating and emotionally numbing myself.  Fat lot of good it’s done me.”

“It probably did at the time, though.  It was a means of self-preservation during those times.”

There was a pause, then I randomly spat out, “I disgust myself.  My vulnerability disgusts me.  I disgust me.  Fucking schizo bitch!”

“You’re one of the most self-critical people I’ve ever known,” C told me, taking a very slight tone of authority.  “My worry is that this is a major stumbling block.  I really think if we can develop some self-compassion in you, it will help a lot.”

“You said a moment ago that dissociation etc was a means of self-preservation.  It ties in with the psychology discussed in a book I’ve been reading.  It is, shock horror, a self-help book, one designed to teach you strategies to soothe yourself when you go mental.”

C was delighted by this.  He asked me if it was any good, my response being that a lot of it (as with any such text) was “wank”, but that despite this, there were some good, and vaguely intelligently written, parts to it.

The thing is, I’m not always as critical of myself as I seem to be in psychotherapy.  I can only surmise that that is when the truth really comes out.  The raw, visceral nature of everything that’s gone or is wrong with my life is so palpable and explicit in those 50 minutes, and the true depth of my self-hate is exposed.  Eugh.

He went on to say that it was not desirable to rid me of my “sarcasm and [my] wit” (he said I was witty!!!  Smiley me!), but that he thought aspects of that fed into my lack of self-compassion, and that we needed to strike a balance.

“And I’m encouraged by the fact that you’re trying,” he concluded.

I left feeling psychologically battered and bruised, even so much as allowing myself a tear as I drove home (how self-compassionate), but I was also quietly encouraged and reassured.

Flogging a Dead Horse with C – Week 35

Christmas and the arrival of 2010 have seen some disruption to your usual service from SI. It seemed impossible to get a chance to write on the latest C session, given as these post seem to be the most ridiculously detailed.

This post shouldn’t be overly detailed, as a lot of it was repetitive bullshit regarding the annoyances of the previous week. Nevertheless, here we go.

Upon leaving C’s company the previous week, we had agreed that we would use week 35, the last week before a break of three weeks owing to Christmas, as a session to discuss how I would manage the so-called festive season.  In reality, that bit ended up taking approximately five minutes at the end, and although it was ever so slightly more helpful than some of the nonsense he’s come off with at other breaks (“breathe!”), it was still not entirely helpful.  But then again, he’s not my guardian, is he?  Much as I would like it that way.

I say we were flogging a dead horse because the majority of the discussion centred around the same crap we had discussed over the previous week (leave a comment or get in touch if you need the password) and the week before that, ie. my anger and distress about his decision to cut short my treatment, and my general disgust about the NHS’s abject failure to adequately treat me since I first sought help for my mental health problems.  I do understand that in some ways maybe C sees exploring my reactions to this as a form of projection or transference, and maybe in some ways it is: perhaps I feel so rejected and aggrieved because that’s how I was meant to feel about my father, uncle, ex, etc etc.

However, it endlessly frustrates me that I cannot just simply be angry because I have been so horribly fucked about by the health service.  Again, in this session, C reiterated that the 24 week limit (starting from tomorrow) was his decision; he said he was “not a robot” controlled by the NHS.

It completely contradicts all the stuff he says about my right to be annoyed and about how BPD should really be treated, and we went round and round in circles on how I could not reconcile his two contrasting views, and about how he either couldn’t or wouldn’t explain it properly.

I also, having decided as a result of the preceding week that he hated me, went to find out whether or not this was indeed the case.

I said, “if I ask you a question, will you promise not to answer with a question?”

He shifted uncomfortably, then admitted that he was unsure as to whether or not this was achievable.

I asked him anyway, on the proviso that if I thought he was “blagging” his way through his answer I would pull him up on it.

He did come off with the form bullshit such as, “why is it important for you to know that?” and whatnot, but I was pleased when he finally admitted that he too had found the preceding week “frustrating”.  So he is a human after all!

He said that I had been “very angry” with him, which I thought was unfair.  I told him that I genuinely hadn’t been angry with him, merely the system, until he confessed to having been the one that decided on the time limit.

“But you were angry with me then,” he pointed out.

“Yes,” I said.  “You had seemed so supportive of me prior to that; you agreed that my situation was wholly unfair.  Then you completely contradicted that by admitting to this arbitrary limit crap.”

And so back we went to flagellating that deceased equine.  More questioning demands from me, more bullet-dodging from him, no progress from either of us.

He had asked me in week 34 to seriously consider whether or not to continue with therapy, as I “had” to agree to the time limit as part of the contract (which strikes me as being quite unreasonable, as contracts are meant to be negotiated rather than forced in this type of setting).  Apparently if I don’t accept the limit, I cannot continue treatment.

“On that note,” I told him, “I am prepared to accept it, but only if you accept – because this works both ways – that I am going to fight it.”

He asked what I meant by ‘fighting’ it, prompting me to withdraw a copy of the letter to the advocacy groups out of my pocket.

“It’s only fair that you read that, given that you’re going to be involved,” I told him, handing the document over.  He took it and began reading.

I sat there and watched him reading it for a minute or two, then stood up and walked to the window, knowing perfectly well that he would almost certainly comment on this, as he had done two weeks previously.  Indeed, he didn’t disappoint.

“I’m wondering why you got up, SI…” he pondered, as he continued reading the letter.

“It’s not reflective of anything,” I spat cynically.  “I’m not denying my hurt or failing to face up to my problems.  I’m simply looking out the window whilst you are occupied with reading that.  Am I not allowed to get up, C?”

He shrugged and muttered something along the lines of that I was, in fact, allowed to get up, then continued reading in silence.

He eventually looked up and said, encouragingly, “it’s a good letter.  Who all are you going to send it to?”

I told him about the advocacy groups, Mindwise and the NI Association for Mental Health.

I was astonished – and delighted – when he then proceeded to actively encourage me to also send it to both the Chief Executive of my Trust, and the head of the mental health directorate of same.  In the end, he forgot to give me the person’s name, but as it turns out it’s been passed to him anyway (more details on how the letter has progressed in a future post).

C said, “you’ve also made reference there to people I think are in England – perhaps it would also be worth adding information about provision for personality disorders in other Northern Ireland Trusts.”

I asked him what such provision existed, knowing that people with the most serious PDs are in fact sent to specialist units in England as there are no facilities to treat them here at all.

C said a self-harm team exists in one of the other Trusts here.  “Although not everyone who self-harms has BPD, and not everyone with BPD self-harms, they would probably see a disproportionately high rate of people with your diagnosis,” he said.  “No such team exists in this Trust at the minute.  There’s discussion ongoing about making the existing team a regional, cross-Trust one, but it hasn’t yet come to anything.”

He talked on for a few minutes about plans our Trust has for action on personality disorders, and how they don’t seem to much be coming to fruition.  But the best part of the session was when he asked me if he could have a copy of the letter.

“I think it would be good for my line managers to know how you feel about all this,” he said.  He went on to say something (I don’t recall what) indicating that there might be some benefit to me in this, but was very quick to point out that it was my choice as to whether or not he did take a copy for them.  I readily agreed, of course, delighting in his apparent desire to act as my advocate to the bureaucrats above him.

Now, of course, I am convinced that he took the letter so he and his twatfaced bosses of evil can formulate some plan of self-defence in advance of hearing from the advocacy groups.  It was not in my interest at all – merely their own.  No doubt over the next few weeks we’ll see which way it actually is.

Eventually – I don’t remember how – I said that he must get sick of his job, what with all the whinging he would have to listen to.  “I accused you of being a sadist a few weeks back,” I said.  “Now I think you’re a mashochist.”

He accused me (sympathetically, to be fair to him) of splitting, which on reflection makes me slightly irritated, but at the time I agreed and called myself all the names of the day for employing this “silly psychological process.”

C leapt to my defence.  He said he knew that I had long since known I was guilty of splitting, but that it’s now “emotional for [me]”, not just something I recognise intellectually.  And it is OK, I do not need to berate myself for it, because I have suffered serious traumas, apparently, that have caused this defence mechanism (which is not silly, he contends) to develop.

On that note, as I recall it anyhow, we moved on to the discussion about the dreaded Christmas.

C’s advice was basically to get the fuck out if I felt anxious or overwhelmed.  I said that was easy to say, but he didn’t have to listen to my mother’s wrath if I did so.

He advised me to talk to her in advance, but I protested against this as well.  “When I told her about what happened with my uncle, she said I made it up to avoid going to his house,” I reminded C.  “So how can I justify my anxiety?”

“Blame your crowd phobia,” C said.  “She can’t be critical of that, can she?  There will be a crowd there, won’t there?

“Yes,” I replied.  “And they’re all part of the problem – it’s not all about my history with my uncle.  I have nothing in common with them and it’s a weird matriarchal set-up, where about 18 different generations all live under the same roof.  They’re freaks.”

He said, “are there children living there?”

I was horrified.  He was obviously wondering if anyone else is presently at risk from Paedo.

“Now you’re angry with me for putting the baby and all the other generations in danger.  I’m sorry,” I raced, in a bizarre panic.

C looked at me, his eyes wide-open.  “Where did that come from?” he enquired, surprised.

“Oh, you’re not angry with me?  Then I’m using you as a board for my anger at myself, am I?”

“OK, you’ve lost me,” he admitted.  “Just…just remember – get out.  Talk to your mother in advance, blame your crowd phobia if you have to, but if you feel yourself becoming tense, get out of there, even if only for a few minutes.  Allow yourself to be anxious about this.  How could you not be?”

And that, folks, was really that.  Of course, you know how ridiculously awful Christmas turned out to be, but I did remove myself from the others when I went so horribly mental, so I suppose I did at least follow the advice given.

As I was leaving, I wished him a Merry Christmas.  He said, admittedly cautiously, “you too,” causing me to laugh bitterly.  I think he knew that it was inevitable that the season would be utterly shite.

So, the three week gap is due to be over tomorrow.  Of course, I am convinced that C is dead again; either that or therapy will be cancelled due to the stupid, horrible, pointless fucking snow, and I need him so desperately at the minute.  Though I have not heard anything about a cancellation today, and I suppose I would have expected an advanced notification were the snow to fuck everything up on the monumental scale that it has in Britain.

The last time he was on holiday, in August, I didn’t miss him that much.  But this time I have, and I need him to help me pick up the pieces of the last few weeks.